Coping with injury: It's a mind game

Krisey Banton knew something "wasn't quite right" when an overhead shot across the tennis court netted an intense pain in her arm.

But it wasn't until the next day when the Novato resident woke up to an arm that had turned black-and-blue that she realized how badly she'd injured herself. The diagnosis: a pectoral muscle torn. The advice: no tennis until it's better.

Seven weeks have crawled by since, and Banton desperately misses a sport that for the past 10 years has been her favorite way to combat stress. It's also a big part of her social life.

"What I miss most, aside from the physical aspect, is the therapy that tennis provided," she said. "If I had a bad day or a bad week, being on the court allowed me to enjoy the sport, my friends, the outdoors, the conversation at the changeovers ... watching is not quite the same."

As isolated as she feels from her treasured pastime, Banton is hardly alone. We're a country that loves playing sports, and the number of participants -- from middle-school soccer players to adult weekend warriors -- grows each year (consider the surge in numbers lacing up for the Oakland Running Festival: in 2010 -- its inaugural year -- 6,300 signed up; this year 9,852 crossed the finish line). Ironically, while being active is a part of a healthy lifestyle, with virtually any activity comes the potential for injury. And while there's no denying the physical challenges can be daunting, it's often the psychological hurdles that are the most difficult to clear.

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The resulting isolation, depression, desperation, mental strain, stress and sense of failure can be as painful as a torn ligament, says Dr. Alette Coble-Temple, of Pleasant Hill's John F. Kennedy University. Coble-Temple, who has spent more than 10 years working with injured athletes, says that dealing with a major injury -- one that may take a person out of his or her sport permanently -- can mirror the grieving process.

"You will be surprised, but 90 percent of what is problematic for injured athletes is not physical," Coble-Temple says. "It is emotional and psychological."

Oakland's Gabby Green knows firsthand the frustrations of dealing with an injury that takes an athlete out of the game. When she was a sophomore. the now-18-year-old basketball star at Berkeley's St. Mary's College High School fractured her ankle. It took from July to January before she played again. The hardest part for her: "When I got back to St. Mary's and (to) watching my team practice and play, and I'm not out there," said Green, who is going to be on the Cal women's basketball team next season.

While having to sit on the bleachers was Green's biggest challenge, some injured athletes find that the loss of activity also means losing their coping mechanism.

"That kind of regular physical activity in some ways is like self-medicating, but in a good way," says Dr. Alan Goldberg, director of Competitive Advantage, an Amherst, Massachusetts-based performance consulting firm. Making matters worse, he says, can be the sudden loss of identity.

"For most serious athletes, it's who they are, what they do," Goldberg said.

Psychological impact

For elite college athletes, being sidelined can also mean no longer feeling like an integral part of the team, says Dr. Derek Van Rheenen, director of UC-Berkeley's Cultural Studies of Sport in Education.

They "will feel like they're not contributing, they are less valued or of less value to the team's larger goals. And so it's a major psychological and collective experience that people I think underestimate," the former college and professional soccer player says. He adds that it's important for coaches, trainers and other players to recognize and support contributions from everyone on the team, and encourage players to become well-rounded individuals who have a diversity of interests.

That's a message that should be shared with the growing number of young athletes who are training more competitively than ever. According to an April 2014 study by the American Academy of Pediatrics, there has been a notable increase in girls, in particular, who experience torn anterior cruciate ligaments or ACLs, one of the major knee ligaments. The report points to how training has intensified for young athletes over the past 20 years and recommends that "specific types of physical training can reduce the risk of ACL injury as much as 72 percent, especially in young women."

More injuries

"There's no doubt that the incoming student athletes now are coming in with a much greater track record of injuries," says Van Rheenen. "Sometimes three, four surgeries by the time they even step foot on a college campus."

Van Rheenen says that for college players, in particular, an injury can lead to self-reflection, even help prepare athletes for the inevitable.

"They have to come to terms with, 'I won't always be an athlete, I won't always have this facet of myself and if it's almost my entire identity, this is really a dangerous road to continue down," he said.

On the upside, those who are able to self reflect, if they come back, will have a more balanced approach to their identification with their sport.

Getting to that point, however, "doesn't happen over night," Van Rheenen says.

Even when recovered, an athlete needs to work out of their tentativeness, mostly for safety's sake.

"For those of us who have had injuries, it can be actually much more dangerous to play when you're constantly thinking 'I may reinjure this,' " Van Rheenen said.

So, even then, once the healing is done and the body is sound, it almost comes down to mastering that mind game.

Refocusing

That was the case with yoga and group exercise instructor Maryam Sharifzadeh, who herniated a disc in her back while setting up the flooring at an Oakland studio she runs with other fitness pros, leaving her unable to practice yoga for six months.

"I went into this 'how do I fix it?' state," said Sharifzadeh. "I skipped over the grieving process, which I don't think was completely healthy, because it came out in other ways. But I went straight into this action, as in, 'what was I going to do to fix this?' "

To avoid slipping into a negative place, she dove deeper into the meditation element of yoga and redirected her focus on other projects, including her involvement in UC Berkeley's WorkFit U, a program that encourages staff and faculty to pinpoint small habit changes toward healthier lifestyles.

And with the blessing of her physical therapist, she returned to another activity she used to participate in: swimming.

"I was trying to highlight the positives," she said. "I was: 'OK what are the things that I've been putting off on the back burner. What are the things that I could do now?"

Today, Sharifzadeh has fully recovered and is back to teaching. Looking back on what happened and her recovery, she's most surprised about how it didn't need to be such a difficult process.

"I realized it was only difficult if I make it difficult," she said. "It's a scary injury to have. But in hindsight, I'm fully functioning now, it hasn't stopped me in my day to day, and it's been exactly one year, and I'm fine. I'm very healthy, and it's made me very grateful for having this very healthy body now."

Tips for dealing with injuries

Try to understand what you're feeling. The loss, the anger, the frustration are a normal part of what happens when you lose something important to you.

Talk to other athletes who have gone through it and coaches who understand it. It's important to have your experience validated.

Set realistic goals when in rehab to avoid increasing the frustration and depression.

Try visualization and relaxation techniques.

Explore taking up a different sport you can do safely or explore other avenues and talents.